• Christopher W Mastropietro, Peter Sassalos, Christine M Riley, Kurt Piggott, Kiona Y Allen, Elizabeth Prentice, Raya Safa, Jason R Buckley, David K Werho, Martin Wakeham, Arthur Smerling, Andrew R Yates, Ilias Iliopoulos, Hitesh Sandhu, Saurabh Chiwane, Asaad Beshish, David M Kwiatkowski, Saul Flores, Sukumar Suguna Narashimhulu, Rohit Loomba, Christine A Capone, Francis Pike, John M Costello, and Collaborative Research from the Pediatric Cardiac Intensive Care Society (CoRe-PCICS) Investigators.
• Department of Pediatrics, Division of Critical Care Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.
• Pediatr Crit Care Me. 2024 Aug 1; 25 (8): 728739728-739.

ObjectivesMulticenter studies reporting outcomes following tracheostomy in children with congenital heart disease are limited, particularly in patients with single ventricle physiology. We aimed to describe clinical characteristics and outcomes in a multicenter cohort of patients with single ventricle physiology who underwent tracheostomy before Fontan operation.DesignMulticenter retrospective cohort study.SettingTwenty-one tertiary care pediatric institutions participating in the Collaborative Research from the Pediatric Cardiac Intensive Care Society.PatientsWe reviewed 99 children with single ventricle physiology who underwent tracheostomy before the Fontan operation at 21 institutions participating in Collaborative Research from the Pediatric Cardiac Intensive Care Society between January 2010 and December 2020, with follow-up through December 31, 2021.InterventionsNone.Measurements And Main ResultsDeath occurred in 51 of 99 patients (52%). Cox proportional hazard analysis was performed to determine factors associated with death after tracheostomy. Results are presented as hazard ratio (HR) with 95% CIs. Nonrespiratory indication(s) for tracheostomy (HR, 2.21; 95% CI, 1.14-4.32) and number of weeks receiving mechanical ventilation before tracheostomy (HR, 1.06; 95% CI, 1.02-1.11) were independently associated with greater hazard of death. In contrast, diagnosis of tricuspid atresia or Ebstein's anomaly was associated with less hazard of death (HR, 0.16; 95% CI, 0.04-0.69). Favorable outcome, defined as survival to Fontan operation or decannulation while awaiting Fontan operation with viable cardiopulmonary physiology, occurred in 29 of 99 patients (29%). Median duration of mechanical ventilation before tracheostomy was shorter in patients who survived to favorable outcome (6.1 vs. 12.1 wk; p < 0.001), and only one of 16 patients with neurologic indications for tracheostomy and 0 of ten patients with cardiac indications for tracheostomy survived to favorable outcome.ConclusionsFor children with single ventricle physiology who undergo tracheostomy, mortality risk is high and should be carefully considered when discussing tracheostomy as an option for these children. Favorable outcomes are possible, although thoughtful attention to patient selection and tracheostomy timing are likely necessary to achieve this goal.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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